Annual Report - Homepage - Yorkshire Ambulance … this software in the coming year. During 2009-10...

Annual Report and Summary Accounts 2008-09

Yorkshire Ambulance Service NHS Trust


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Vision and Values

Introduction

Chairman and Chief Executive’s Foreword

Performance Update

Developing and Delivering Quality Care

Being Prepared

Our Patients

Our Staff

Training

How we Work

Trust Board

Operating and Financial Review

Statement on Internal Control

Remuneration Report

Independent Auditors’ Report

Summary Financial Statements



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SYorkshire Ambulance Service NHS Trust


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Yorkshire Ambulance Service NHS Trust was established on 1 July 2006 when the county’s three former services merged.

It covers almost 6,000 square miles of varied terrain from isolated moors and dales to urban areas, coastline to inner cities. We employ 3,900* staff and provide 24-hour emergency and healthcare services to a population of more than fi ve million. Over 2,100 volunteers also make a vital contribution to the service.

* 3,900 is a headcount fi gure. It equates to 3,520 whole-time equivalents.



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Our Vision: We aim to deliver an excellent ambulance service for Yorkshire that is clinically focused, fi nancially sound and continuously develops its services to meet the needs of the future.

Our Values: We aim to encourage an open culture in which staff at all levels can have the opportunity to understand and infl uence the vision, strategy and objectives of the Trust:

Clinically Focused: Everything every one of us does is for the patient

One Team: We work together to provide the best patient service

Responsive: We listen and we respond quickly

Exemplary Service: Skilled, professional, working to high standards and passionate about improving patient healthcare

Ambulance stations

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Yorkshire Ambulance Service (YAS) began 2008-09 on the back of strong progress towards building a single, cohesive patient-focused organisation following the merger of three former trusts.

We did, however, face a number of challenges. These included the new Call Connect response target, introduced from April 2008; considerable fi nancial and quality issues in our Patient Transport Service (PTS); and continued growth in the number of calls from patients above commissioned levels.

The publication of Lord Darzi’s Next Stage Review and the NHS Yorkshire and the Humber Healthy Ambitions strategy paved the way for many positive developments in joined-up patient care. YAS is working in partnership with other NHS organisations to design and deliver these service changes and to ensure we are prepared for the associated increases in demand for emergency and urgent ambulance care and patient transport.

We are pleased to report substantial progress in many important areas during 2008-09.

Safer and More Responsive Services

Right People, Right Response, Right Care

In our Accident and Emergency (A&E) services we demonstrated signifi cant improvements in the recording and delivery of high quality clinical care through improvements against fi ve nationally-agreed clinical performance indicators.

We made expanding and developing our A&E workforce a key priority with a major recruitment drive and the introduction of new frontline roles.



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The recruitment process is ongoing but already we have more staff working on the frontline than at any time since the Trust’s formation. This will help us to achieve the Healthy Ambitions aim of ensuring every life-threatening emergency is responded to by someone with paramedic skills as a minimum, so we can provide enhanced care on scene, resulting in fewer people requiring hospital treatment.

We have invested in our 999 communications centres, recruited new staff, developed existing employees and consolidated our service into two facilities in Wakefi eld and York. New systems and technology are already enabling us to provide a more responsive service for the people of Yorkshire. We are responding to patients faster than ever before, although we recognise the need to make further improvements over the coming year.

Our PTS now benefi ts from new leadership and a single structure across Yorkshire. Research tells us that patients recognise and appreciate the dedication and commitment of our crews but get frustrated with the inconsistency of our service. A new emphasis on quality, investment in technology and renewed dialogue with partner organisations is helping to turn our service around and put it on a sustainable fi nancial footing for the future.

The snow and prolonged cold weather in December 2008 and February 2009 presented real challenges for YAS - both in terms of levels of demand and the diffi culties we faced reaching patients due to hazardous road conditions.

Staff from operational and support teams pulled together to ensure that we continued to reach patients needing emergency care and provided transport for those with essential hospital appointments, such as renal patients needing dialysis. Ensuring we are prepared for emergencies and can provide our services whatever the circumstance continues to be at the top of our agenda, demonstrated by our signifi cant programme of staff training and investment in equipment and IT.

Well Managed, Well Led

We know that the nature of our service makes management a really tough job and that we need to support our managers to develop their skills. We also need leaders who have a clear, shared vision of YAS as a top-quality provider of healthcare and can inspire and guide us to work together to achieve this goal.

That’s why we launched our Leading Edge management and leadership development programme this year. So far 61 people have started the Transformational Leadership programme under Leading Edge and we will be extending it further during the coming year.

It is also vital that we have enough managers to support a service that works 24 hours a day, seven days a week, 365 days a year and we are developing our management structure to give us increased capacity in our frontline services.

High Quality

Safe, high quality patient care is central to absolutely everything each one of us does and the improvements we have made against the national clinical performance indicators demonstrates our commitment in this area.

Moving forward we continue to focus on how we can best evaluate the quality of our services, learn lessons and take on board best practice.

In 2008-09 one of our big achievements in this area was to obtain Level 1 compliance with the NHS Litigation Authority’s Risk Management Scheme for Trusts. This shows the signifi cant progress we’ve already made but also highlights the challenge ahead to embed and realise the benefi ts from new ways of working.

Looking Ahead to 2009-10

Much of our work over the last year has been about getting the basics right and establishing fi rm foundations. Now, with these in place, we expect to achieve real benefi ts for the people of Yorkshire: getting to patients more quickly, using enhanced skills to respond to their needs on scene and where this is not possible, providing transport to the most appropriate place of care.



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“Safe, high quality

patient care is central to absolutely

everything each one of us does...”

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EYorkshire Ambulance Service NHS Trust


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Service Development

Signifi cant investment has been made in the two 999 communications centres in Wakefi eld and York where additional staff have been recruited to support the new Call Connect targets.

The transfer of the South Yorkshire 999 Communications Centre in Rotherham to a new state-of-the-art centre at Ambulance HQ in Wakefi eld took place on 4 June 2008. A new, more effi cient and resilient C3 computer aided dispatch (CAD) system, together with digital radio, was also introduced.

The Central 999 Communications Centre team in Wakefi eld joined their South Yorkshire colleagues in the new purpose-built centre on 11 November 2008.

The next phase of the project is to introduce the new C3 CAD system into the Central division during 2009-10. It is already used by South Yorkshire staff and in the York 999 Communications Centre. This will bring the Trust one step closer to creating a virtual communications centre across the York and Wakefi eld sites.

A new alternative response desk opened in the Central 999 Communications Centre on 28 September 2008 which is specifi cally dedicated to improving the dispatch of fi rst responders and BASICS doctors. It is already proving to be benefi cial in getting fi rst responders to patients quicker and more frequently than ever before.

Prior to its launch YAS was dispatching around 15 responders a week; now we dispatch an average of 15 per day.

Our Advanced Medical Priority Dispatch System (AMPDS), which is used to support the care of patients while waiting for the ambulance to arrive, was upgraded to improve the clinical aspect of 999 call-answering services. There are plans to further improve this software in the coming year.

During 2009-10 further investment is planned in the 999 communications centres with continued development in ‘hear and treat’ services and alternative pathways, as well as improvements to the deployment of resources and completion of the roll-out of digital radio.

Developments within our urgent care service are also high on our agenda, supporting projects including the new West Yorkshire urgent care model and the new national three-digit number to simplify access for the public to urgent healthcare.

As well as handling emergency calls, we also manage out-of-hours calls diverted from some GP surgeries when they are closed. We have continued to provide this service for primary care trusts (PCTs) across Yorkshire, in addition to some district nursing services and NHS and private dental services.

Business Intelligence

A new department was created - Business Intelligence - which incorporates Management Information and Resource. It aims to develop the capability of these teams to ensure we have the right staff, with the right skills, in the right place at the right time to meet patient needs. It also provides information to support decisions on the shape of YAS in the future.

“The new purpose-built 999

communications centre in Wakefi eld has state-of-the-art

technology which enables us to respond to the needs of patients even more effectively than before – it’s great

to be a part of some really exciting developments within the

ambulance service.”

Ryan Burrows, Dispatcher, Communications Centre,

Wakefi eld

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A&E Operations Update

Many years ago the basic training for those working in the ambulance service used to centre on the three Ps of ambulance aid: Preserve life, Prevent deterioration and Promote recovery. Over the years these fundamentals have not changed and remain as important to patient care today as they were then.

Our prompt arrival on scene and the delivery of the best clinical care really does make a difference, so the achievement of the nationally-set response times is imperative.

New Performance Standard

From April 2008, a change was made to the way in which ambulance response times are measured so that they more closely refl ect the experiences of our patients and callers. The main intention of this change was to improve patient care by reaching critically-ill and injured patients more quickly. It was introduced as a result of a recommendation in the Department of Health’s 2005 report, ‘Taking Healthcare to the Patient: Transforming NHS Ambulance Services’, known as the Bradley Report.

Previously we started our measurement from the point at which we had obtained a caller’s location, telephone number and chief complaint. Now the clock starts immediately a call is connected to our 999 communications centre - hence ‘Call Connect’.

It effectively means that the clock starts measuring our response times 90 seconds earlier than before, although national response targets remain the same. These are to reach Category A (life-threatening) calls in eight minutes and Category B (serious but not life-threatening) calls in 19 minutes.

It’s been a diffi cult target to reach not only for YAS, but for other ambulance services across England. During 2008-09 we worked towards achieving the target of responding to 75% of Category A calls within eight minutes. We achieved this in September 2008, but the particularly challenging winter period, with disruptive weather conditions and signifi cantly more 999 calls (a 7% increase on 2007-08), meant that it was not achieved for the rest of the fi nancial year. During the latter part of the fi nancial year (1 January - 31 March) 70%+ was reached on 71 out of 90 days.

Despite this, YAS was acknowledged as the most improved ambulance service in England during the last year and this is particularly reassuring for our patients. Our frontline staff have shown exceptional commitment which continues to make a real difference to the performance improvements we are now seeing.

Improving our Services

For us at YAS the introduction of Call Connect was part of a wider programme to improve our services for the people of Yorkshire. In A&E Operations we enlisted the assistance of performance improvement consultants Lightfoot Solutions and Landmark Consulting to help us operate more effectively. They have been very successful in working with several other ambulance services across the country to identify optimum standby locations and ‘drive-zones’ for A&E crews and their input at YAS has proved benefi cial.

We are answering calls more quickly, dispatching vehicles more promptly and reducing vehicle mobilisation time, so we are reaching patients quicker than ever before. We have extra frontline staff and more due to qualify during the coming year, additional standby points to ensure our staff are best placed geographically to respond to incidents, more vehicles and improved technology. This increased capacity and capability has added to our resilience.

The ‘Lifecycle’ bicycle response teams in York and Leeds remain a valuable A&E resource in busy city centre locations. A pilot operation, funded by the YAS Charitable Trust, has been running in Sheffi eld since the beginning of 2009 and a full evaluation of its effectiveness will be carried out to try to secure funding from the local primary care trust (PCT).

Introduced during 2007-08, our clinical managers continue to work alongside the locality managers and clinical team leaders to provide support to all operational staff and ensure that we are delivering best practice at all times. Clinical team educators are now in place across the county to help staff with their training and education development needs.

Photograph courtesy of David Bocking

“Call Connect is a new Government response standard which was introduced

to improve patient care by reaching critically-ill and injured patients more

quickly. Since its introduction, it’s good to hear that YAS has become the most

improved ambulance service in England.”

Tracy Wright, EMT, Doncaster

“The Cycle Response Unit not only

improves our effi ciency to respond to patients in the city

centre but gives us the valuable opportunity to be more visible and

responsive in the local community.”

Jonathan Alexander, Paramedic, Sheffi eld Cycle

Response Unit

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E Urgent Care

Sending an ambulance is not always the most appropriate response to an urgent or emergency call and we have worked hard towards placing more emphasis on helping patients access alternative sources of care. Our new alternative response desk (see page 9 - Service Development) has been instrumental in taking some of the pressure off our 999 emergency operation. Better use of our emergency care practitioners (ECPs) in Sheffi eld, Scarborough and Leeds has also resulted in a reduction of unnecessary journeys to hospital for patients and reduced workloads for A&E crews.

In addition, we have appointed a new urgent care director who has developed the Trust’s urgent care strategy and is working closely with commissioners to see how YAS staff can become more involved in urgent care pathways across Yorkshire. A pilot site has been established in Hull.

A Frequent Callers’ Pilot Project has now been running since the start of 2009 to identify frequent callers to YAS who require help, but not necessarily assistance from our A&E crews.

YAS is working in conjunction with relevant PCTs to identify issues relating to any frequent callers and taking steps to put alternative care pathways in place. This means that those callers will be able to gain access to more appropriate services - for some this will be a personal care package, community psychiatric assistance or home support.

Actions such as this are already helping to reduce the number of times these patients call 999 for an ambulance. NHS Yorkshire and the Humber (the strategic health authority) has supported the implementation of new web-based software which will support the development of pathways. This is being piloted by a number of PCTs in the region.

We are also working on reducing hospital turnaround times to ensure patients receive a prompt transfer of care to emergency department staff and our ambulances and staff are made available for the next emergency call.



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Network Response

YAS has continued to work with the Yorkshire Air Ambulance charity to provide an improved airborne response to emergencies.

Eight extra paramedics from YAS were recruited onto the aircrew in February 2009. The additional capacity will enable the charity to operate its two helicopters from Sheffi eld City Airport and Leeds/Bradford Airport seven days a week (during daylight hours). Dr Jez Pinnell, an A&E consultant, has also been recruited as a medical advisor for the air ambulance.

Our Network Response team has been busy training professionals from other organisations in life-saving techniques, including 12 coastguards along the East Coast. There are also plans to improve links with mountain rescue teams throughout Yorkshire.

Continued efforts have been made to increase the number of volunteer community fi rst responders who can provide the initial response to certain emergencies, saving vital seconds before the arrival of an ambulance crew.

We now have around 1,900 members who belong to over 250 schemes throughout the county.

Partnership Working

Our innovative Police and Paramedic initiative, where the two services work together on late-night weekend shifts and on bank holidays in city centres, has continued to operate successfully in Hull, York and Wakefi eld. It has also been used during bank holiday periods and weekends in Leeds, Sheffi eld and Doncaster to attend incidents such as drunkenness or domestic violence.

We have also continued to work closely with our NHS partners, particularly in those areas where there have been signifi cant service changes. Service reconfi gurations have occurred on the East Coast in Bridlington and Scarborough (cardiac services and acute medical), Huddersfi eld and Halifax (maternity services) and Hull (cardiac services). Through partnership working these changes have been managed in a coordinated way with continuity of care for patients being key.

“Being a Community First

Responder is so rewarding because you are able to learn valuable new skills and provide vital life-saving treatment to patients in your community.”

Tony Glover, Community First Responder,

Ackworth

“ECPs bring healthcare to the patient.

We help to ensure that patients receive the most appropriate care

at the most appropriate time in the most appropriate place. This results

in a reduction of unnecessary journeys to hospital for patients and reduced workloads for our colleagues who work on emergency ambulances.”

Michael Long, ECP, York

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Yorkshire Air Ambulance.

Having additional staff means the

charity is able to extend the available

fl ying hours of both its helicopters,

seven days a week.”

Colin Jones, Yorkshire Air Ambulance Paramedic

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Operational Plan

The Executive Team compiled an Operational Plan for the fi rst quarter of 2009-10 focusing on the sustained achievement of the 75% Category A performance level and continued development of patient care through our Clinical Performance Indicators (CPIs) - see page 20 for further information on the CPIs. The A&E Operations team continues to work closely with the Clinical Directorate to ensure that our patients receive the very best clinical care.

Following signifi cant investment by the PCTs which commission our services, we are committed to demonstrating the improvements we made during 2008-09 to meet the nationally-set targets and provide better care for patients by reaching them more quickly.

New Regional Operations Centre

During 2009-10 a new Regional Operations Centre (ROC) will be set up to build on the success of the Performance Impact Team (PIT) - a team which provided high level support to the operational areas and enabled them to deliver the best service for patients and monitor our performance targets.

The ROC will be responsible for keeping a close eye on activity 24/7 and coordinating the twice-daily conference calls between all relevant teams.

In addition to supporting the performance of the Trust, the ROC will become the focus for seasonal pressures so any diffi culties arising can be coordinated and handled effectively.

Emergency Preparedness

Our focus has been to build on the foundations laid in 2007-08 for emergency preparedness by further developing our systems, plans and staff to be able to effectively manage a serious or major incident.

The year began with staff trained in decontamination undertaking a refresher course. These staff, equipped with specialist kit, can be sent to incidents where people have been exposed to a hazardous substance so the contaminant can be washed off before conveyance to hospital (if injured).

The Major Incident Plan was approved by the Trust Board in May 2008 and is now in operation. Management teams have received familiarisation training about the plan which was consolidated by exercises. We also continually review other plans and procedures, whether they are site-specifi c plans such as football stadiums, pop concert venues etc, or plans to deal with a certain type of incident, eg adverse weather.

Major incident training continued throughout the year with YAS participating in six live exercises and 16 table top exercises.

Our Urban Search and Rescue (USAR) team carried on supporting operations both locally and nationally by responding to incidents involving collapsed structures and entrapments in buildings, both above and below ground.

Development towards implementation of the Hazardous Area Response Team (HART) continued with a start date scheduled for July 2009. The USAR team will be incorporated into the HART providing a 24/7 capability to the people of Yorkshire.

Winter always presents its own challenges due to the increased demand placed on the service, particularly over Christmas and the New Year, and the adverse weather associated with the time of year. We have detailed plans to ensure we can effectively manage the service during the winter period.

This year, however, the demand placed on the Trust was way in excess of what we had anticipated, and exacerbated by severe weather conditions, the Trust implemented its Major Incident Plan in December 2008.

This presented the Trust with a good opportunity to test the plans and processes which have been developed for a major incident over a protracted period and ultimately identifi ed various learning points which have been, and continue to be, implemented.

Patient Transport Service

Our Patient Transport Service (PTS) provides non-emergency transport for people who are unable to use public or other transport because of their medical condition and includes those:

• attending hospital outpatient clinics

• being admitted or discharged to or from hospital wards

• needing life-saving treatments such as chemotherapy or renal dialysis.

We undertook more than 1.5 million journeys across Yorkshire in 2008-09 with 850 staff using 460 specialised vehicles and the support of 170 volunteer drivers, community transport schemes and approved taxi services. PTS has also provided signifi cant support to the A&E service throughout the year, working evenings and weekends on patient discharges, transfers and admissions where it has been clinically safe to do so.

We have to make sure that the service is centred around our patients’ needs and that it is good quality, responsive, fl exible and gives value for money.

An initial review of our PTS highlighted that the service faced signifi cant fi nancial diffi culties in a

challenging operational environment which impacted on its quality.

The review included input from frontline staff, union representatives, managers and the Executive Team and formed the basis of a long-term recovery plan.

The plan focuses on improving planning, dispatch and ambulance control, and automating processes, where possible, using technology piloted in two areas from April 2008.

Personal Digital Assistants (PDAs) are being introduced across the Trust. These small mobile computer units help us capture more accurate data and identify where our service is up to standard and where it requires improvements so we can continue to enhance patients’ experiences. An assessment of their value has revealed excellent results which is helping us to deliver an improved service to patients across Yorkshire.

“Since Personal Digital

Assistants have started to be introduced our Patient

Transport Service has operated more effectively and we have

been able to deliver an improved service to our patients.”

Steve Ramsden, Leeds PTS

“Being part of the HART team means that, for the fi rst time,

we are able to provide medical support in the danger zone

of an incident.”

Emma Livesey, HART Clinical

Team Educator

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Accident and Emergency Performance: We received 671,700 urgent and emergency calls - an average of over 1,800 calls a day. We responded to a total of 564,819 incidents of which 216,272 were categorised as immediately life-threatening.

Patient Transport Service Performance: We made 1,547,191 journeys transporting patients to and from hospital and treatment centre appointments.

Target 2007-08Performance (pre-Call Connect)

2008-09Performance (Call Connect)

Category A 8 minute response

75% 73.5% 69.44%

Category A 19 minute response

95% 96.2% 96.11%

Category B 19 minute response

95% 92.4% 90.60%

The ‘Call Connect’ standard which was introduced on 1 April 2009 means that the clock now starts when the 999 emergency call is connected to the ambulance 999 communications centre and not after three pieces of key information have been obtained by the 999 communications centre (location, telephone number and chief complaint), which was the case previously.

The key response target of reaching 75% of Category A patients with life-threatening illnesses or injuries within eight minutes remains the same, as does the key response target of reaching 95% of Category B patients (serious, but not life-threatening) within 19 minutes. These are nationally set targets.

Please note, the pre-Call Connect equivalent fi gures for 2008-09 performance are as follows:

Category A 8 minute response - 79.18%

Category A 19 minute response - 96.54%

Category B 19 minute response - 92.05%

We have successfully begun implementing our online booking service for hospital wards and clinic staff. The time-saving simple-to-use system means hospital staff don’t have to telephone us to let us know when their patients have fi nished their treatment and are ready to go home. We have also extended our facility for hospitals to download transport bookings directly from their Patient Administration System (PAS), a resource used routinely by hospitals across Yorkshire.

PTS made a vital contribution to maintaining business continuity in the bad weather over winter. Staff successfully transported all patients who needed high-priority pre-booked hospital treatment, such as dialysis. PTS also helped hospitals to keep their A&E departments fl owing well by transporting patients who were well enough to be discharged home.

These developments during the year have provided a springboard for the PTS Re-design to be implemented during the coming year.

Continuous development of our planning, dispatch and ambulance control systems and the roll-out of automated and technological solutions will improve our effi ciency and the service we provide. Coupled with our commitment to invest in the training of our highly-regarded PTS staff, these developments will ensure we continue to provide a PTS that meets the high standards expected by the people of Yorkshire.

Annual Health Check 2007-08

The Government published Standards for Better Health in July 2004, which set out 24 Core Standards describing a minimum level of service which patients have the right to expect.

The Healthcare Commission (HCC) has been keeping an annual check on all local healthcare organisations ensuring standards are achieved during a one-year period. This is known as the Annual Health Check.

The Annual Health Check process is made up of two key elements:

• Use of Resources (how effectively an organisation uses its resources)

• Quality of Services (an organisation’s performance against Core Standards, existing standards and new national targets).

The ratings are graded as ‘excellent’, ‘good’, ‘fair’ or ‘weak’.

The HCC published its 2007-08 Annual Health Check performance ratings for all NHS organisations in England in October 2008.

YAS received an overall assessment of ‘fair’ for the Use of Resources element and ‘weak’ for Quality of Services for the April 2007 - March 2008 period.

The Use of Resources score is externally monitored as part of the Auditors Local Evaluation Framework. The ‘fair’ rating refl ected the Trust’s improved fi nancial position following a successful turnaround period.

The ‘weak’ rating for Quality of Services was infl uenced by the merger of three ambulance trusts into YAS. This had a knock-on effect on performance and Core Standards as policies and procedures required streamlining and performance issues had to be tackled.

YAS has continued to make signifi cant improvements during 2008 to develop a robust framework for monitoring compliance against standards and ensuring a comprehensive assurance framework is in place. The Trust also continues to work closely with Yorkshire and the Humber Strategic Health Authority and NHS trusts throughout the region to improve performance. We are committed to improving performance against each of the Annual Health Check elements and have identifi ed compliance as a key priority.

The HCC has continued to monitor YAS during the year and has acknowledged that we have made signifi cant progress towards achieving the standards which we were not compliant with in 2007-08.

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Clinical Governance

The Trust is committed to the development and delivery of quality clinical care and services for patients which the Clinical Governance Committee continues to oversee. The committee has been enhanced this year by representation from additional YAS groups including Access and Response and PTS. We have also introduced an Expert Patient to ensure that patients have a voice in the decision-making process to improve clinical culture, quality of care and service delivery.

Clinical Standardisation

This year has seen the achievement of clinical practice standardisation to JRCALC (Joint Royal College Ambulance Liaison Committee) 2006 Guidelines and the standardisation of clinical consumables throughout the Trust. There will be ongoing in-depth reviews of all clinical consumables and the introduction of four remaining JRCALC drugs during 2009-10. This year will also see vehicle-based drugs standardised throughout the Trust and the roll-out of controlled drugs across YAS.

Looking forward, we plan to standardise non-disposable items of clinical equipment, medical gas supplies and defi brillator monitors. We also plan to introduce single-patient drug packs which will improve effi ciency and patient safety.

New Treatment for Stroke

Over the last ten years, treatments for strokes which have been caused by a blood clot, have developed to offer these patients a drug treatment that can almost reverse this disabling condition for some. YAS has agreed pathways to refer these patients to appropriate hospitals for rapid assessment and treatment. The patients need to present within three-and-a-half hours of fi rst symptoms, therefore, acute stroke is now managed as a medical emergency by YAS and the call-handling response has been modifi ed to refl ect this.

Pathways

Throughout the year two clinical pathway advisors have worked with stakeholders and healthcare providers to introduce many new care pathways including:

Diabetes/Hypoglycaemia - Following a 999 call for a hypoglycaemic episode (where blood sugar has fallen very low), patients across much of the YAS area are referred to diabetes specialist nurses who follow up with the patient. Referred patients have reported how they now better understand the importance of monitoring their blood sugar, how to recognise warning signs of low blood sugar and how to prevent further hypoglycaemic episodes. From January to December 2008 a total of 814 patients were referred, a number of these patients required an adjustment to treatment which was identifi ed through this pathway. Roll-out to the remainder of the YAS area is planned for 2009-10.

Falls - Pathways for referral of patients after a fall continue to be developed in all areas. In Leeds there are on average 60 to 80 referrals per month. In the Bradford area 999 calls for patients who have sustained a fall are assessed on the telephone by clinical advisors and may be attended by community teams who can put long-term care plans in place, rather than ambulance service clinicians.

Community matrons - Links between community matrons in the Kirklees area have led to the development of emergency care plans which are kept at a patient’s house. If an ambulance is called to a patient with a care plan, the crew can easily fi nd the brightly-coloured folder containing specifi c information about the patient’s care. This enables the ambulance crew to better decide the most appropriate care pathway for the patient and where appropriate, contact the community matron.

Epilepsy - A pilot has commenced in the Doncaster area for the referral of patients with epilepsy who are not transported to hospital but have been attended by an ambulance crew as a result of a 999 call after a fi t. The patients are referred to epilepsy specialist nurses who contact the patient and arrange a follow-up if necessary.

We will continue to link with healthcare partners to work towards the development of further care pathways to improve patient care.



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“Many new clinical pathways have

been developed over the last year and the benefi ts for patients

are clear to see. These include referring them to specialist nurses to help them manage their condition better or putting long-term care plans in place to reduce further

incidents such as falls.”

Mani Dulay, Clinical Team Leader, West Yorkshire

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E Extended Role Practitioners

2008-09 has seen further developments in the extended role practitioner workforce. Increasing numbers of paramedic practitioners have completed training and are in post in South Yorkshire, whilst the emergency care practitioner services continue to deliver high quality patient care. We plan to further develop the extended role practitioner services to ensure that patient care best meets patient need across Yorkshire.

Clinical Performance Indicators

In 2008 national Clinical Performance Indicators (CPIs) were introduced for ambulance services. They are aimed at supporting clinicians and services in providing safe, effective, patient-centred, timely and effi cient healthcare. There are fi ve national indicators which focus on Stroke (TIA), ST Elevation Myocardial Infarction (STEMI), Cardiac Arrest, Asthma and Hypoglycaemia.

Since our involvement in the pilot which concluded in March 2008, we have worked with staff to raise awareness of the CPIs and their importance in demonstrating the quality of care provided to patients. Further results have shown that YAS has demonstrated signifi cant improvements in the provision of quality clinical care.

Clinical Audit

The Clinical Audit department has continued to contribute to national audits on cardiac chest pain and CPIs. Locally we provide data and advice to YAS clinical staff to assist them in completing clinical audits.

During 2008 a standardised paper-based patient report form (PRF) was introduced ensuring we can capture clinical data consistently throughout the Trust. Linked with this we are developing electronic systems to process the captured data supporting the provision of accurate clinical reports. Staff have been instrumental in performing audits on the completion of the PRFs, identifying potential areas for improvement.

Our commitment to clinical audit will continue by ensuring that staff have the necessary information and skills to audit their practice.



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Research

Over the last year the Trust has made signifi cant progress in beginning to develop research and development processes. This is due to engagement with the UK Comprehensive Research Network (UKCRN) and the West Yorkshire Comprehensive Local Research Network (WYCLRN) supporting YAS on behalf of the other research networks within our area. As a result of this relationship, we have secured funding from the WYCLRN to make possible the secondment of an experienced Research and Development Manager to conduct analysis relating to research and set up initial processes to support research activity.

We are a member of the National Ambulance Research Steering Group (NARSG) and, along with colleagues from other services, are beginning to forge good links nationally around the development of research within ambulance services. We already engage with Medical Research Council-funded research, specifi cally the DAVROS study (Development And Validation of Risk-adjusted Outcomes for Systems of Emergency Medical Care) in association with the School of Health and Related Research (ScHARR) at Sheffi eld University.

Our medical director and assistant medical directors have had research papers published in the Emergency Medical Journal (EMJ) in the last 12 months, a measure of both the enthusiasm of the staff within YAS to engage in research and the level of clinical expertise within the Clinical Directorate.



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“Traditionally, ambulance services have been measured on response times and thanks to the introduction of clinical

performance indicators, YAS is now able to demonstrate signifi cant improvements in the quality of

its clinical care.”

Suzi Morris, EMT, Ripon

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Infection Prevention and Control

Improving infection prevention and control (IPC) compliance, which is monitored by the Strategic IPC Committee, Integrated Governance Committee and Trust Board, was one of the key objectives for YAS this year. Our compliance increased steadily against the Health Act code from 72% at the start of the year to 91% in March 2009. Part of this improvement related to policy and guidance development as well as improved cleaning provision of vehicles and premises being implemented uniformly across YAS.

We launched the National Patient Safety Agency (NPSA) cleanyourhands campaign in July 2008 with staff training and awareness initiatives, internal hand hygiene audits and the recruitment of 110 cleanyourhands ‘champions’.

Members of the Health, Safety and Risk team worked with the Department of Health, NPSA and the Ambulance Service Network on a variety of national IPC projects to improve and unify procedures nationally.

We completed our application to the Care Quality Commission (CQC) prior to the deadline for an IPC licence from 1 April 2009. YAS was registered with conditions relating to the updating of policies and procedures on IPC and healthcare associated infections (HCAI). Action plans were put in place to meet these requirements by the end of June 2009.

At the end of August 2009, and following an unannounced inspection by the CQC of our work to prevent HCAI, the Trust has now met all requirements and is fully registered.

During the year the Trust completed its own local audits, was assessed by Internal Audit as having signifi cant assurance against the requirements of the Health Act code, had its IPC policy approved for Level 1 Risk Management Scheme for Trusts and was audited by the Healthcare Commission.

Dr Alison Walker, Director of IPC for YAS, prepared a report to the Strategic Trust Board in February 2009 around the importance of the prevention of HCAI, our cleanyourhands campaign and improvements to our IPC compliance.

Clinical Incident Reviews/Lessons Learned

As part of the continuous development and monitoring of clinical services, the Trust has a robust process for reviewing adverse clinical episodes. This method is encouraged as part of the open and honest culture that the Trust has nurtured to offer a structured process to all clinical staff involved with patient care, including staff in the 999 communications centres.

During 2008-09 clinical incident review panels have taken place. They have considered aspects of clinical care that have occurred through a variety of circumstances to identity individual and organisational lessons learned, outcome measures and recommendations to avoid recurrence of similar events in the future. Registers are maintained of all clinical incident reviews and these are now forming an integral part of a Trust register to determine lessons learned.

Clinical Leadership

We are developing the clinical leaders within our organisation to improve clinical quality. A cross-section of potential YAS clinical leaders have attended events, providing an opportunity to discuss clinical leadership, defi ning clinical leaders and improving our clinical performance. This work will continue with future events highlighting the excellent clinical leadership currently demonstrated within YAS and further developing and empowering our clinical leaders.

We have also contributed to the national group which has produced a framework for clinical leadership for NHS ambulance services.

“We have made signifi cant

investment in our fl eet with 99 new vehicles, both PTS and A&E, purchased across

Yorkshire over the last year.”

Mick Farmer, Assistant Director of Fleet

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We have invested heavily to ensure that we can continue to provide effi cient, appropriate and comfortable transport for all our patients, whatever their needs.

During 2008-09 the Trust purchased:

• 33 new ambulances

• 19 PTS stretcher vehicles

• 19 replacement rapid response vehicles (RRVs)

• 25 additional RRVs

• 3 additional emergency preparedness vehicles.

To improve the management of vehicle breakdowns across the Trust, the Fleet Operational Support Centre (OSC) at Springhill, Wakefi eld, opened 24 hours a day, seven days a week, from 19 January 2009.

The vehicle repair workshops in Leeds and Bradford provided an enhanced service by opening around the clock from 6.00am on Monday through to 5.00pm on Friday to improve effi ciency and provide additional support to frontline staff.

A 24-hour incident reporting helpline was established to improve the way in which staff can report road traffi c accidents involving Trust vehicles.

There has also been a full restructure and harmonisation of ancillary staff, such as vehicle and station cleaners, including a dedicated manager and three additional supervisors.

Over the next year, a new central workshop facility will open in Wakefi eld and the Hull workshop will be relocated to Carlton Street in Hull.

As part of the nationwide procurement initiative, a ‘drive and try’ event was held on 12 March 2009 to give A&E frontline staff the opportunity to evaluate vehicles built to the national specifi cation for English ambulance services. Their feedback on the various types of vehicle will inform the YAS replacement of A&E vehicles during 2009-10.

Estates

Extensive work has been carried out to develop a number of ‘fi ve-star’ emergency standby response buildings in strategic locations across Yorkshire to improve our response to patients. Although there have been a number of delays fi nding suitable land, drawing up agreements with landlords, obtaining planning permission and connecting to utility supplies, 24 of the original 26 sites are now fully operational and with a further two sites added, just four remaining locations are yet to be established.

There has been signifi cant progress with a number of capital scheme acquisition and disposal projects. Building work has started on:

• the new York Ambulance Station at Yearsley Bridge which is due to open later in 2009-10. The station moved from its long-standing location in Dundas Street in the spring of 2009 to temporary refurbished premises at Clifton Hospital until the new location is ready.

• one of two new ‘mini-hub’ ambulance stations in Hull and work commenced on the second site in July. They will replace Hull Central Ambulance Station and are scheduled to become operational later in 2009.

• the replacement ambulance station in Penistone which is also scheduled to become operational later this year.

Approval has been granted for a new ambulance station within the health centre complex at Wetherby. As this site is an existing Local Initiative Finance Trust (LIFT) scheme, the development has been made possible through close partnership working arrangements with the local authority and Leeds Primary Care Trust.

The sale of Bramham Ambulance Station has effectively been put on hold due to the downturn in the property market, as advised by our property developers and district valuers.



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Other successful projects completed during the year include:

• the refurbishment of the 999 Communications Centre at Wakefi eld

• full refurbishment of Sherburn Ambulance Station

• replacement roof and internal refurbishment of Honley Ambulance Station

• internal building work at Bradford Ambulance Station

• new offi ce extension at Wakefi eld Ambulance Station

• the installation of a number of rapid action garage doors which have reduced ambulance egress times by up to 15 seconds.



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“We have carried out refurbishments of a number

of ambulance stations, including Bradford, and this will continue

over the coming year. Staff have been involved in choosing colour schemes,

furniture and fi ttings and we have had some really positive feedback.”

Mark Squires, Assistant Director of Estates and Procurement

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Safeguarding Children, Young People and Vulnerable Adults

A YAS-wide Safeguarding Children and Young People Policy and Procedure was launched in July 2008. This aims to ensure that the welfare of children is promoted and safeguarded and that all children are safe and protected by effective intervention if they are thought to be suffering, or likely to suffer signifi cant harm.

Since the introduction of the new policy and procedure, the Trust now makes an average of 30 referrals per week to Children and Young People’s Services (CYPS), compared to fi ve per week during the previous year. This increase indicates that YAS staff are being more vigilant for signs of neglect and abuse and also feel more confi dent in making referrals that raise those concerns.

A Safeguarding Vulnerable Adults Policy and Procedure has also been developed and is awaiting approval from the Trust Board.

Specialised training relating to safeguarding children, young people and vulnerable adults forms part of all induction, update and development courses. Distance learning courses on safeguarding children, young people and vulnerable adults have also been introduced and staff can now access multi-agency education events.

Almost 600 staff completed training courses in 2008-09 which re-emphasises the Trust’s commitment to protecting the welfare of children, young people and vulnerable adults.

Equality and Diversity

We employ staff and provide a service for patients from a large and culturally diverse community. We actively challenge discrimination, promote equality and respect human rights in accordance with current legislation and good practice.

YAS is part of the national Pacesetters programme which aims to reduce health inequalities by working with local communities. The inequalities are those arising from discrimination on account of age, disability, ethnicity, gender, religion and sexual orientation.

In 2008-09, we have been working on four patient-focused projects as part of the Pacesetters programme and have been liaising with local communities to improve services for patients. The projects are:

• To pilot the implementation of a Community First Responder Scheme with a gypsy and traveller community based in Leeds. This scheme aims to provide them with the skills and technology to provide basic life support within their own community. It will also deliver an education programme to recognise life-threatening symptoms and give guidance on how to access appropriate medical assistance. The aim of this pilot is to learn how to effectively work with the gypsy and traveller community to introduce this type of scheme with the ultimate goal of improving their access to healthcare as well as their life expectancy.

• To introduce a Community First Responder Scheme designed to meet specifi c cultural and religious needs. West Yorkshire has a Muslim population of 7.2% (2001 Census). Evidence shows that this group suffers poor health and that their life expectancy is lower than the national average. Evidence also shows that members of the Muslim community do not access emergency care until the last moment, even in life-threatening situations. The aim of this project is to improve their access to emergency care services and their life expectancy.

• To improve patient pathways for patients with mental health and alcohol and/or drug-related issues. The Yorkshire and Humber region has a high percentage of alcohol and drug misuse. The aim of this project is to improve emergency care access for patients with a mental health and alcohol and/or drug-related illness by providing a single point of access and improving patient outcomes.

• To improve patient pathways for elderly patients suffering falls. The Yorkshire and Humber region has an ageing population with 8% over 75 years of age (2001 Census). The aim of this project is to work with primary care to offer advice and support to elderly patients and to provide an increasing range of services/pathways for elderly patients to reduce unnecessary hospital admissions.



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“The Community First Responder scheme is

a great initiative and one that the West Indian Welfare Society is

more than happy to support. Hundreds of people pass through the doors of the

Al-Hikmah Centre in Batley every day and I’m sure they appreciate that help is

never too far away in an emergency.”

Musa Kazi, Centre Manager at the Indian Welfare Society Al-Hikmah

Centre, Batley

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Gauging the views of our patients and the public about the services we provide is an important aspect of how we shape our future development.

Compliments and Complaints

The Trust is always pleased to receive compliments about the quality of service provided to patients. In 2008-09 we received 474 letters of appreciation and commendation, complimenting staff for their professionalism and dedication.

There are times when the standard of service is perceived to have fallen below what is expected. However, it is remarkable to note that the Trust recorded one formal complaint for every 5,600 journeys. In 2008-09, YAS received 280 formal complaints. Of those, 275 (98%) were acknowledged within two working days and 268 (96%) were fully responded to within the target of 25 working days. A further 143 complaints were received from other healthcare professionals.

The three main themes were:

• response times for Category C and urgent calls

• PTS waiting times to go home after treatment

• staff attitude.

Our complaints procedure is based on the Principles for Remedy, which are set out by the Parliamentary and Health Service Ombudsman.

The new role of patient services manager was introduced to provide overall management of all complaints and compliments.

A Patient Services Helpdeskwas launched to provide a gateway for enquiries relating to everything from complaints, compliments and concerns to requests for information, lost property and police, solicitor and court enquiries.

A new leafl et entitled ‘How to make a comment, pass on a compliment, raise a concern or make a complaint’ has also been produced.

During 2008-09, YAS was part of a national pilot scheme running in the Hull and East Riding area to trial a new way of dealing with formal complaints. The recommendations from the pilot scheme came into force nationally on 1 April 2009 as revised regulations for health and social care organisations.

PALS

Our Patient Advice and Liaison Service (PALS) has continued to develop throughout the year, providing free, confi dential health service advice and information.

PALS dealt with more than 1,162 enquiries during the year.

PALS can be contacted by writing to:

Patient Services Department Yorkshire Ambulance Service NHS Trust Headquarters Springhill 2 Brindley Way Wakefi eld 41 Business Park Wakefi eld, WF2 0XQ

Tel: 0845 122 0535Email: [email protected]



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Patient and Public Involvement

We are committed to gaining feedback from patients and the public about the services we provide.

We have been developing relationships with our Local Involvement Networks (LINks), which cover 13 local authorities in Yorkshire and aim to give citizens a stronger voice in how their health and social care services are delivered. Consultation on service development has also taken place with overview and scrutiny committees as well as various community groups.

At a patient and carer involvement event on 5 August 2008, attendees reviewed our new ‘How to make a comment, pass on a compliment, raise a concern or make a complaint’ leafl et to make sure it was easy to understand and in the appropriate format. They also presented their fi ndings as ‘mystery shoppers’ of our new Patient Services Helpdesk. In addition, feedback was given on our plans to establish a Critical Friends Network which aims to enable a range of stakeholders to engage with the Trust on different aspects of service provision.

Staff, patients and carers were given the opportunity to evaluate a range of PTS stretcher vehicles at an event on 27 November 2008. The feedback obtained about various types of design will inform the YAS specifi cation for the replacement of stretcher vehicles.

Photograph courtesy of Yorkshire Evening Post

“I would like to thank the ambulance crew

who came to help my little girl Georgia when she became very poorly

at home earlier in the year. Georgia is doing well now, but without

them there to help that night, it is likely to have been a very different outcome.

They both went above the call of duty to help and words can’t describe how

thankful we are.”

Leeanne Brown, Sherburn-in-Elmet(YAS crew - Amanda Marshall and

Andy McLoughlin)

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Supporting Staff

We have introduced a new policy ‘Employee Well-being and Support’ as YAS recognises that health service employees, particularly ambulance service staff involved in an adverse event (eg attendance at a particularly serious incident) may feel traumatised to a level which may affect them personally and/or professionally. This new policy sets out the many mechanisms of help and support available and how to access them.

In support of this policy, the Trust has also started to deliver specifi c post-incident support training delivered by an in-house specialist in post traumatic stress which will be rolled out across the Trust in 2009.

We have also introduced other polices in support of our staff including Stress Management at Work and as a result have created an Employee Well-being Focus Group which will look at the factors contributing to staff well-being whilst at work.

In addition, we support staff by providing a free and widely accessible Occupational Health Service (OHS). It includes direct access to specially-trained OHS nurses with referrals to doctors, physiotherapists and other specialists if necessary. In addition we provide a free and confi dential counselling service, which members of staff can access in relation to either work or personal problems.



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192 A&E Operations

During the period of 1 April 2008 to

31 March 2009, the Trust recruited 568 new members of staff.

Of these 192 joined A&E Operations, 88 joined Access and Response,

201 joined PTS, with the remaining 87 joining support departments.

Between April 2008 and 31 March 2009 the HR and Training department conducted 37 weekend assessments and several evening events with more to follow

during the remainder of this fi nancial year in support of the

Workforce Plan.

“A total of 201 staff have joined PTS over the

last year as part of our ongoing commitment to

improving non-emergency patient transport across YAS.”

Jennifer Smith, Operational Team Leader,

Leeds PTS

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The Trust is working with its recognised Staff-side representatives (UNISON and Unite) to develop a YAS Partnership Agreement. The purpose of the Partnership Agreement is to set out a framework agreed by YAS and its trade unions which outlines how they as partners will work together to promote effective partnership working on workforce issues. The agreement will recognise respective roles and responsibilities, establish shared values and a common purpose and set some key principles for effective joint working. It will provide the basis for a continually improving partnership which will lead to long-term workforce solutions that benefi t both staff and patients.

Keeping Staff Safe

All our staff have the right to a healthy and safe working environment. This is why we exercise zero tolerance in relation to violent or aggressive acts, whether it is physical or verbal.

Our local security management specialist (LSMS) is committed to helping us create an environment which is secure so that the highest possible standard of clinical care can be delivered to patients.

Our staff were subjected to 243 recorded incidents involving physical and verbal abuse between 1 April 2008 and 31 March 2009, compared to 229 during the previous year. Part of the reason for this increase is improved awareness amongst staff about the importance of reporting such incidents because we must ensure that appropriate action is taken through the criminal justice system against those who commit these acts.

During 2008-09 there were 19 successful prosecutions resulting in sanctions ranging from fi nes and police cautions, through to community service and prison sentences.

Over the last year, information and leafl ets on basic security were distributed to all staff and station premises. We also launched an around-the-clock hotline to give staff an additional channel to report any acts of violence or aggression.



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Listening to Staff

YAS undertakes an annual staff survey to gather the views and opinions of staff about a range of issues affecting their working lives.

The fi ndings of the 2007 staff survey identifi ed the following as priorities for action:

• increase the number of staff having well-structured appraisals

• reduce the amount of work pressure felt by staff due to demands of the job

• improve the extent of positive feeling within the organisation primarily through communication, staff involvement and innovation.

During 2008-09 we actively addressed these priorities by:

• delivering appraisal training

• developing an on-line notifi cation system of completed appraisals

• asking managers to agree a timetable for completing appraisals for their staff

• developing a stress management policy

• carrying out job-specifi c stress risk assessments

• including sessions on health and safety and counselling at corporate inductions for all new staff

• successfully prosecuting a number of offenders under our zero tolerance approach to violence against staff

• introducing specifi c directorate newsletters

• introducing weekly email updates from the chief executive to all managers

• continuing with regular Listening Watch visits where directors visit staff in their workplace to talk and receive feedback.

As part of the 2008 staff survey questionnaires were sent to all staff, 44% of whom responded. The fi ndings of the 2008 survey show that we have made improvements in the areas highlighted above. In 2009-10 we will continue address these corporate priorities.



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APR MAY JUN JUL AUG SEPT OCT NOV DEC JAN FEB MAR

2006-07 N/A N/A N/A 4.83 4.78 4.96 4.83 5.72 5.06 6.44 6.76 6.08

2007-08 5.57 5.64 4.71 5.41 5.95 6.18 6.89 7.76 8.65 8.05 6.78 6.64

2008-09 6.81 6.77 6.31 6.2 5.65 5.74 5.70 5.34 5.94 6.22 5.08 4.73

Net change on 2007-08

1.24 1.13 1.6 0.79 -0.3 -0.44 -1.19 -2.42 -2.71 -1.83 -1.83 -1.51

During the winter of 2008-09, OHS offered free fl u vaccinations for staff at clinics across the Trust.

All new staff, or those transferring roles, attend a corporate induction. A new YAS staff handbook has been launched which features useful information about the Trust and its different departments.

The HR department has launched a dedicated HR webpage on the YAS intranet which provides vital information for staff. Available 24-hours a day, it supports staff who work shifts and might not be able to access the HR department during the day.

Sickness Absence

The table on the right shows our overall absence fi gures for each month of 2006-07 and 2007-08 for comparison with the equivalent month in 2008-09. The average reported absence for NHS trusts is 4.5% and for ambulance trusts is 6%. YAS has a cumulative absence rate of 5.87% for the period April 2008 to March 2009 which is slightly above the average national rate for NHS trusts and a little lower than the absence rate for other ambulance services.

Sickness Absence Percentages

The fi rst workshops which were individual focus groups for both management and Staff-side took place on 20 November 2008, followed by a joint workshop on 11 December 2008. Further meetings took place in January 2009. The feedback shows that this has been a positive fi rst step in developing more effective partnership working which continued throughout early 2009, during which time details of the actual agreement and a strategy for developing staff engagement were developed further.

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Clinical Team Educator (CTE) Scheme

During 2008-09 a number of additions and improvements were made to the CTE scheme, including the development of safe practice portfolios, candidate workbooks and an online reporting system which will be upgraded to include their work.

Student Paramedic

The fi rst 15 YAS student paramedics graduated at the University of Teesside gaining a Foundation Degree in Paramedic Science during 2008-09.

60 student paramedics commenced their year one programme during 2008-09 and will graduate as paramedics in 2010-11.

Technician to Paramedic Conversions

During 2008-09, 64 places were made available on IHCD paramedic courses and 39 places with Sheffi eld Hallam University. This has allowed a large number of Emergency Medical Technicians (EMTs) to become paramedics.

Assistant Practitioner

During 2008-09, YAS introduced the new role of assistant practitioner. This role will operate alongside a paramedic or EMT on an A&E operational vehicle. The Education and Development department has developed an education programme which is presently an in-house award. However, it is hoped this programme will be accredited by one of our partnership universities.

Technician to Advanced Technician Uplifts

A programme was introduced to uplift all EMTs to advanced EMTs, thereby giving them additional skills in airway management, 12-lead ECG interpretation skills and drug therapy.

Acute Coronary Courses

During 2008-09 the acute coronary course was introduced to give all paramedics the knowledge and skills needed to signpost patients for Primary Percutaneous Coronary Intervention (PPCI) or deliver thrombolysis.

IHCD Police Driver Training

During 2008-09, the Education and Development department designed and delivered a new national driving tutor training programme in conjunction with the IHCD. This programme enables police driving instructors to deliver IHCD ambulance emergency driving courses.

Placement Co-ordinator

Due to the large number of hospital placements which are required to meet both the student paramedic and technician to paramedic programmes, we have employed a full-time placement co-ordinator.

E-learning

The Education and Development department has commissioned a number of e-learning programmes. These include subjects such as manual handling and mechanism of injury. These programmes will allow students to undertake education in different formats, allowing the department to meet student needs.

Statutory and Mandatory Training

This year saw the creation of a more co-ordinated approach to learning and development. The Education and Development team is responsible for statutory and mandatory training as well as a wide range of non-clinical learning interventions.

During the last year tutor-led training was provided to support compliance with regulatory and legislative requirements on:

• basic life support

• safer moving and handling

• health and safety

• fi re safety and prevention

• infection prevention and control.



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“I’ve been an EMT for two years and

it’s great to be given the opportunity to progress within

the organisation to paramedic level.”

Sam Wilkinson, embarking on her technician

to paramedic conversion

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specifi c statutory and mandatory training needs and induction provision - signifi cant effort has been made to ensure that statutory and mandatory training is provided in a way that minimises the impact on operational services but maximises the opportunity for staff to gain the skills and knowledge required to enable safe working and minimise risk. A mix of workshops, exercise books and e-learning is now being provided to all YAS staff.

Creating a fully qualifi ed workforce - a team of Union Learning Representatives (ULRs) and Life-long Learning Advisors (LLAs) are being developed in partnership with Staff-side. By promoting learning at local levels we aim to increase participation from non-traditional learners within the Trust. Contextualised Skills for Life courses are planned for 2009 to assist staff with few, or no educational qualifi cations to gain a National Adult Literacy qualifi cation (equivalent GCSE at grade C).

Improving learning and development administrative and reporting systems - the Oracle Learning Management system has been implemented to plan, record and monitor all learning and development activities within the Trust.

Expansion of commercial training for service re-investment - ambulance services in Yorkshire have been providing a wide range of pre-hospital care training services to the NHS, local community and many other organisations for over 15 years. A planned expansion programme is now underway to increase income in order to re-invest into improved patient services.



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Openness and Accountability Statement

The Trust complies with the Code of Practice on openness in the NHS and has various channels through which the public can obtain information about its activities.

We are committed to sharing information within the framework of the ‘Freedom of Information Act 2000’ and all public documents are available on request.

We hold a public Trust Board meeting every two months. An Annual General Meeting is held in September each year. In common with the Board meetings this is open to the public with specifi c time set aside for questions.

We always welcome comments about our service so we can improve performance.

If you have any compliment, complaint or query, please do not hesitate to contact us.

Environmental Policy

YAS aims to ensure that our buildings and all the goods and services we procure are manufactured, delivered, used and managed at the end of their useful life in an environmentally and socially acceptable way.

All our tenders are evaluated using whole-life costs, where applicable, to assess the environmental costs over the life of the products or services offered. Our suppliers and those seeking to tender for business are made aware of the requirements of our environmental policy.

We also work to minimise the health, safety and environmental risks to our patients, staff and visitors, in accordance with health and safety at work and fi re legislation and the Disability Discrimination Act 1995.

Work has been carried out to measure the Trust’s carbon footprint and a management team has been established to look at ways of making YAS more environmentally friendly. An action plan to look at ways of reducing our carbon emissions was approved by the Trust Board in March 2009.

The Trust’s carbon footprint has been measured in line with the Carbon Trust methodology and the results are shown below:

Information Governance

YAS aims to ensure that the personal data it holds is accurate and held securely in accordance with the appropriate legislation and standards outlined in the NHS Information Governance Toolkit.

During the year there have been no Serious Untoward Incidents involving personal data that would need to be refl ected in this report.

The security of information, communication and technology (ICT) has developed over the last year with the encryption of mobile devices across the Trust.

The Senior Information Risk Owner for YAS is Keeley Townend, the ICT Director.



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Improving mandatory training was a priority over the last year. The Education and Development team offers a wide variety of non-clinical learning including mandatory training, core induction, Knowledge and Skills Framework (KSF) and Personal Development Review (PDR) training, vocational qualifi cations and a full range of e-learning and distance learning provision. Work continues on mandatory training into 2009 with 514 days of tutor-led workshops scheduled to support the safety of staff and the patients they care for.

We have continued to work towards achieving our learning and development objectives which are:

Better and more systematic identifi cation of training needs - a unique online learning and development portal was launched to empower managers/reviewers to record, track and monitor PDRs. All individually identifi ed training needs are tracked by the portal and will be used centrally to form the Annual Training Prospectus for 2009-10.

Fairer access to learning and development opportunities - an online application for learning and development activity was introduced to enable the effective monitoring of the equality of opportunity across YAS.

YAS Carbon Footprint Calculation

Tonnes/CO2

Energy Use (Gas & Electricity) 4,835.0

Travel 7,249.0

Waste 5.6

Total 12,089.6

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Chairman

Dr Nick Varey

The overall role of the Chairman is to lead the executive and non-executive team and ensure that YAS meets its objectives for performance, service delivery and clinical governance.

Chief Executive

Martyn Pritchard

The Chief Executive provides the organisation with its strategic leadership and direction. Working with the chairman, executive and non-executive directors, key partners and stakeholders, the Chief Executive develops and maintains a shared vision of the strategic aims, values and culture of the Trust.

Director of Finance and Deputy Chief Executive

Simon Worthington

The Director of Finance is responsible for ensuring that the Trust achieves its fi nancial targets and has robust systems to monitor its fi nancial performance. In addition, the role involves deputising for the Chief Executive, managing the Trust’s integrated business planning function and being the lead director for fl eet, estates, programme management and performance turnaround.

Director of Operations - A&E

Ian Walton

The Director of Operations - A&E is primarily responsible for improving and maintaining the delivery of cost-effective A&E services and meeting national performance targets for responding to emergencies and delivering Call Connect. This role is also responsible for the Trust’s emergency planning provision and security management.

Medical Director

Dr Alison Walker

The role of the Medical Director is to champion high quality patient care. By providing expert clinical governance and guidance, this role helps the Trust to deliver safe, reliable and appropriate care for its patients.

Director of Organisation Development and Human Resources

Rosie Johnson

The Director of Organisation Development and Human Resources is primarily responsible for the development of the Trust’s HR and workforce strategies. Other core responsibilities include human resource management; education, development and training; equality and diversity; organisational development; Improving Working Lives; health, safety and risk; occupational health; child protection and vulnerable adults.



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Director of Information, Communication and Technology (ICT)

Keeley Townend

The Director of ICT is responsible for the Trust’s Access and Response centres, resource planning, out-of-hours services as well as the Trust’s IT infrastructure and management information.

Director of Operations - PTS

Sarah Fatchett

The Director of Operations - PTS is responsible for delivering a responsive and effi cient Patient Transport Service for the whole of Yorkshire, working closely with acute and primary care trusts to win and maintain contracts for PTS.

Director of Urgent Care

Jo Pollard

The Director of Urgent Care is responsible for developing the future urgent care strategy for YAS. The role involves working with a range of individuals and agencies to develop pathways to enable more integrated working with other urgent care providers.

Acting Director of Corporate Affairs

Fiona Barr

The Director of Corporate Affairs is responsible for managing the reputation of YAS, its internal and external communications and relationships with the public, patients, stakeholders and the media. The role also involves patient and public involvement, the Patient Advice and Liaison Service (PALS), complaints and Standards for Better Health.



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Executive Directors

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Nancy Murgatroyd was Non-Executive Director for one of YAS’s former services, Tees, East and North Yorkshire Ambulance Service (TENYAS) and has specifi c interests in audit and governance. She has also served as a Non-Executive Director for the York Hospitals NHS Trust and was chairman of Middleham Key Partnership Ltd. Nancy worked in the design industry for 24 years, and is an internationally exhibited artist.

Nina Wrightson OBE is a Chartered Safety Practitioner and currently Chairman of the British Safety Council. She was a Risk Management Director for Northern Foods plc and has also worked for the Health and Safety Executive, the Government Offi ce for Yorkshire and the Humber and Nestlé Rowntree. Nina is also a Non-Executive Director of the NHS Litigation Authority.

Richard Roxburgh is a chartered management accountant with extensive fi nancial and commercial experience. Former roles include Finance and Commercial Director with Arriva Trains Wales and Finance Director with Arriva Trains North. Earlier career experience includes senior fi nancial positions with BT Cellnet (now O2), and BT Business Division throughout the UK.

Roger Holmes CB is a former Chief Executive of St John Ambulance and a current council member of the South and West Yorkshire branch. Roger has held senior posts in the Department of Trade and Industry and a number of large commercial organisations, including Dunlop and the Chloride Group where he was a main board director, and the Royal Mint where he was Chief Executive.

Rev Stuart Ellis (resigned 31 December 2008) is a Methodist Minister as well as a part-time primary school teacher with North Yorkshire County Council. Stuart is involved in a range of local youth, community and charity projects. He has commercial experience from Norwich Union where he held a senior middle management post relating to client and administration management in the life and pensions sector of the business. He was also a Non-Executive Director at TENYAS.

Paul Osborne (joined 1 April 2009) has extensive experience in general management, including signifi cant responsibility for fi nance, governance and change leadership. He has worked in a number of blue chip organisations in the Technology and Services sectors, as well as customer-facing call centre environments where he was responsible for directing operations and problem resolution. In recent years he has been based at O2 in Leeds where he has fulfi lled the roles of Head of IT and latterly the Head of Technology Transformation.

Name Nature of Interest Organisation

Dr Nick Varey DirectorTrustee

Yorktest Laboratories LtdYorkshire Cancer Research

Roger Holmes Council Member St. John Ambulance (South and West Yorkshire)

Nina Wrightson Non-Executive DirectorChairman

NHS Litigation AuthorityBritish Safety Council

Rev Stuart Ellis EmployeeEmployee

Methodist ChurchNorth Yorkshire County Council

Paul Osborne Employee Telefonica 02 (UK) Ltd

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During the year the Board and senior management team engaged in a process to develop a fi ve-year business plan for the organisation. The plan was approved at the March 2009 Trust Board meeting and came into effect from 1 April 2009. It identifi es how we will achieve eight strategic objectives:

• Clinical Excellence. Ensuring that everything we do leads to patient benefi t, excellence in clinical care and access to the most appropriate and timely care for all our patients.

• Resilience. Maintaining business continuity at all times, whilst having the capacity and ability to respond appropriately to emergencies or crises.

• Our Patients. Putting patients at the heart of our work by ensuring that every policy and practice supports their physical and mental well-being.

• Our Partners. Proactively working together with our partners to deliver integrated services that meet current and future standards for world-class healthcare.

• Quality. Embedding the Principles of Quality throughout the Trust to deliver continuous improvements in all our services.

• Our People. Recognising that the excellence, professionalism, well-being and personal development of our staff and volunteers are key to the success of everything that the Trust does.

• Environment. Creating a high-quality, effi cient and safe workplace that reduces our negative impact on the environment.

• Finance. Delivering sound fi nancial management and value for money.

By establishing this fi ve-year business plan we have taken a major step forward in our business processes. We can demonstrate:

• a clear vision for the future

• measurable strategic objectives

• an understanding of our market and our stakeholders plans

• realistic but ambitious service development plans

• sound fi nancial plans

• clear appreciation of business risk to mitigate its impact

• a rationale for foundation trust status.

The plan will be implemented through the annual business cycle of the Trust. It will be refreshed on an annual basis so that we always have a fi ve-year view of the future. The fi rst refresh of the plan will be the Integrated Business Plan that will support our foundation trust application.

Service Performance

A detailed overview of service performance in 2008-09 is provided in the ‘Performance Update’ section of this annual report on page 8.

Looking forward into 2009-10 the Trust is planning to deliver substantial service improvements as follows:

• It is anticipated that the A&E service consistently achieves national target performance of reaching 75% of patients within eight minutes for Category A calls as measured under the ‘Call Connect’ standard.

• There will be signifi cant improvement in Category B response times. Our commitment is to deliver the national target performance of 95% of responses in 19 minutes.

• Our Hazardous Area Response Team (HART) will become fully operational by July 2009.

• The PTS improvement plan will continue to be rolled out.



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Financial Performance

Income and Expenditure

The Board formally recognised the improvement in the Trust’s underlying fi nancial position by normalising its fi nancial management arrangements after the successful conclusion of our voluntary fi nancial turnaround programme.

We have maintained appropriate control of our expenditure through 2008-09. A small surplus of £151k or 0.0008% of income has been delivered. This was against the balanced budget that the Board approved in March 2008. We are planning to deliver a balanced income and expenditure position in the coming year.

Income

We received income of just over £187m in 2008-09. This is 20% greater than the income received in 2007-08. The breakdown of this income can be seen in the diagrams on the right. It included £15m of non-recurrent funding from commissioners to buy additional capacity to improve A&E service performance and £1m non-recurrent funding in recognition of the high fuel prices during the year. Income is expected to rise to £196m in the coming year. £4.5m of this income is non-recurrent to buy additional capacity in the fi rst quarter.



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Total Income - By Financial Year

£m

2006

-07

2007

-08

2008

-09

2009

-10

Plan

A&E (80.20%)PTS (15.60%)

Total Income - By Type

Other (2.80%)

GPOOH (1.00%)

Events (0.40%)

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We spent £186.5m on revenue items in 2008-09. This is 20% greater than the expenditure in the previous year. The breakdown of the spending can be seen in these diagrams.

Expenditure is expected to rise in 2009-10 in line with income. Areas of investment in 2009-10 will include achieving full establishment on the A&E workforce, investment in improved operational and risk management and delivering training to improve the staff skills mix.



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Total Expenditure - By Financial Year

£m

2006

-07

2007

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2008

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2009

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Plan

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Total Capital Expenditure - By Financial Year

£m

2006

-07

2007

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2008

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2009

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Total CapitalExpenditure -

By Type

IT (18%)

Equipment (18%)Vehicles (36%)

Estates (28%)Pay

(72%)

Non Pay (23%)

Total Expenditure - By Type

Depreciation (4%)

PDC Dividends (1%)

Supplies and services - clinical (7.34%)

Supplies and services - general (4.77%)

Consultancy services (4.36%)

Purchase of healthcare from Non-NHS bodies (3.63%)

Other (1.96%)

Transport (42.30%)

Establishment (17.83%)

Premises (17.81%)

Non-pay expenditure -

By Type

Pay expenditure -

By Type

A&E (67.33%)

Support Functions (17.95%)

PTS (14.08%)

Board (0.64%)

Cash Releasing Effi ciency Savings

We planned to achieve £6.7m savings in the year. £4.4m savings were delivered. The difference was due to the non-achievement of the PTS cost improvement target.

Looking forward to 2009-10 we are targeting a further £9.3m savings. This is an ambitious target so we have put aside a reserve of £2.8m to cover potential non-recurrent slippage.

Capital Expenditure

We spent £14.6m on capital expenditure in 2009-10 which is 73% more than in 2007-08. The breakdown of the spending can be seen in the graphs below.

Cash/External Financing Limit/Loans

YAS ended the year with a cash balance of £5m. However, the Trust overshot its External Financing Limit (EFL) by £612k as reported in the accounts. This overshoot of its EFL, resulted from the Trust holding a lower cash balance than that required to meet its EFL because of a misunderstanding around the link between the EFL and the Net Borrowing Requirement. It is important to note that the Trust does not have a cash shortfall and this issue is not related to liquidity problems. The EFL overshoot did not result from any underlying liquidity issue or unplanned need for external fi nance. Measures have been put in place to ensure that this does not happen again.

The Trust does not have any loans.

Capital Cost Absorption Rate

We achieved 3.5% capital absorption rate. This is within the tolerances set by the Department of Health (of between 3% and 4%). The 2009-10 fi nancial plan allows for a 3.5% achievement against this target.

Better Payment Practice Code

The Better Payment Practice Code requires that we aim to pay all undisputed invoices by the due date or within 30 days of receipt of the goods or a valid invoice which ever is the later. 65.6% of non-NHS trade invoices by number and 67.6% by value were paid within the target. 56.3% of NHS trade invoices by number and 76% by value were paid within the target. The poor performance against this target does not refl ect our underlying liquidity but is due to the administrative system that supports the payment of invoices. We have plans in place to improve this.

Impact of the Economic Downturn

We have made an adjustment of £9.4m to the carrying value of our land and buildings to refl ect the impact of the economic downturn on prices. In line with guidance issued by the Department of Health this adjustment has been taken to the revaluation reserve through the statement of recognised gains and losses.

Our fi ve-year fi nancial plan has accounted for potential impact of the economic downturn on NHS fi nances going forward.

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The Trust Board is accountable for internal control. As Accountable Offi cer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Offi cer Memorandum.

Chief Executive

Has overall responsibility for risk management.

Medical Director

Takes the lead for clinical governance including clinical risk management.

Director of Finance

Has responsibility for fi nancial and estates-related risk management. The Director of Finance is also the lead executive supporting the audit committee and has responsibility for maintaining the Board Assurance Framework.

Director of Corporate Affairs

Has responsibility for supporting all directors and managers and coordinating non-clinical risk activities, Standards for Better Health programme and Care Quality Commission registration process. The Corporate Affairs Director is the lead offi cer supporting the Integrated Governance Committee.

Director of Organisation Development and Human Resources

Has responsibility for supporting all directors and managers on health and safety issues.

NHS Yorkshire and the Humber both supports and monitors the Trust’s development of risk management practice.

YAS works with its partners through:

• the PCTs in Yorkshire and the Humber contracting with the YAS Consortium led by Bradford and Airedale Teaching Primary Care Trust

• membership of clinical networks across Yorkshire

• service level agreements/contracts with NHS trusts and foundation trusts to which we provide patient transport and other services

• membership of the Regional Resilience Forum and the four local resilience forums in the Yorkshire area in relation to emergency preparedness.

2. The Purpose of the System of Internal Control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to:

• identify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives

• evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them effi ciently, effectively and economically.

The system of internal control has been in place at YAS for the year ended 31 March 2009 and up to the date of approval of the annual report and accounts.

3. Capacity to Handle Risk

Leadership is displayed through the Trust Board-approved Risk Management Strategy and Assurance Framework within which the Trust Board, directors, managers and staff can operate effectively.

The organisation’s capacity to handle risk was improved by a reorganisation of director portfolios in April 2009. This review replaced the Governance Directorate with the Corporate Affairs Directorate.



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The health, safety and risk department was reassigned to the Director of Organisation Development and Human Resources and responsibility for business planning and the maintenance of the Assurance Framework was assigned to the Director of Finance.

An Integrated Governance Committee was established as a sub-committee of the Board in July 2009. This replaced the Governance Committee. The Integrated Governance Committee meets fi ve times a year. It provides assurance to the Board that all risks associated with the organisation’s activities are effectively controlled and that those controls are reviewed on a regular basis.

The Board approves the full Assurance Framework at the start of the year and does a full year-end review. The Board receives exception reports on red Assurance Framework risks at each meeting. The Integrated Governance Committee reviews the full Assurance Framework at each meeting. A Risk Register is in place detailing all corporate and directorate-level risks.

The Trust employs an infection control nurse, has an assistant director of health, safety and risk and a full-time security management specialist. These roles are supported by fi ve safety systems managers operating at a local level. Together their role is to support the organisation, its managers and staff to implement the Risk Strategy.

The Board and assistant directors have had risk management training. This training is being rolled out to middle and front-line managers. Regular update training will be given.

Risk management and health and safety form part of the corporate induction process for new starters into the organisation.

Specifi c aspects related to risk management are incorporated into other training courses, for example violence and aggression, health and safety, moving and handling, fi re training and cardio pulmonary resuscitation.

Forty managers are trained in root cause analysis techniques. When required these managers form part of multi-disciplinary teams that investigate serious patient-adverse events. The culmination of this type of investigation is a risk management action plan. This identifi es the process by which lessons are learned and practices changed to improve patient and staff safety.

4. The Risk and Control Framework

The key focus for the Trust has been to establish the Trust Governance Framework. This continues to develop in line with the concept of the Integrated Governance Model.

Public stakeholders are involved in YAS activities. There is a Patient and Public Involvement Committee.

The Risk Management Strategy itself contains a programme of action and embraces the following issues:

• delegation of Responsibility and Risk Management Structures

• cultural

• clinical

• employee

• environmental

• risk identifi cation, analysis, control and review

• incident reporting.

The identifi cation of risk in the organisation is both reactive and proactive. YAS monitors risks which are identifi ed through the reactive processes such as complaints and incident reports, both clinical and non-clinical. All are reported to the Integrated Governance Committee and in summary to the Board.

Proactive processes allow the identifi cation of risks via risk assessments, business planning processes, external assessments and internal self-assessments.

YAS has developed its risk grading matrix from the AUS/NZ 4360 standard. All identifi ed risks, incidents and, in the future, complaints will be graded in accordance with this matrix. Those incidents or complaints with residual risks are entered onto the Risk Register at the appropriate level.



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The Clinical Governance Committee is responsible for the development, monitoring and implementation of strategies which seek to:

• develop and improve the quality of services provided by the Trust

• improve patient safety by reducing the likelihood of exposure to clinical risks through adopting safe clinical practice

• ensure that staff and patients have a say in the decision-making and design process of systems and procedures aimed at improvements in culture, quality of care and service delivery.

The Trust’s Health and Safety Committee is established with its role based on information contained within the Approved Code of Practice relating to Safety Representatives and Safety Committee Regulations 1977 as amended by the 1992 UK Management Regulations and the 1996 UK Consultation with Employee Regulations. Its aim is to:

• ensure the provision of the most effective health and safety structure appropriate to the Trust’s activities

• keep under review the measures taken within the Trust to ensure the health and safety of all employees.

• Internal Audit - To oversee the effective operation of Internal Audit, review the internal audit programme and consider the fi ndings of the Annual Internal Audit Report prior to submission to the Board.

• External Audit – To maintain and enhance the effective relationship with external audit. To agree the nature and scope of the external audit and to review External Audit Reports ensuring their recommendations are implemented.

• Financial Statements – To review the Annual Financial Statements before submission to the Board and to ensure compliance with Standing Orders and standing fi nancial instructions.

The Audit Committee Terms of Reference have been agreed this year in line with the publication of the latest Audit Committee Handbook.

The Integrated Governance Committee oversees the implementation of the Trust’s Risk Strategy. Its role is to ensure that:

• there are sustained improvements in the quality of clinical care and avoidance of harm to patients

• risks to staff are minimised and a healthy environment maintained

• risks to contractors and the public are minimised

• lessons learned from any adverse event, result in change in practice, procedure and/or protocol.

Within this Governance structure the Board is responsible for ensuring that:

• principal objectives are agreed (strategic and directorate)

• the principal risks which may threaten the achievement of objectives are evaluated and control measures put in place in order that the Trust can manage these risks effectively

• plans are in place to take corrective action where gaps have been identifi ed in relation to principal risks

• dynamic risk management arrangements are in place including, crucially, a well-founded Risk Register.

The Audit Committee is established in accordance with the Trust’s Standing Orders. It provides an independent and objective view of internal control.

Its principal duties are:

• Internal Control - Oversee the maintenance of an effective system of internal fi nancial control and management reporting.

• Controls Assurance - To ensure that the organisation has the relevant control standards in place.

My review is also informed by:

• external audit reports

• Standards for Better Health Core Standards Self Assessment Declaration

• the Care Quality Commission registration process

• ongoing self-assessment in respect of the Auditor’s Local Evaluation

• internal audit reports.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, Audit Committee and Integrated Governance Committee, Clinical Governance Committee and the Health and Safety Committee. A plan to address weaknesses and ensure continuous improvement of the system is in place.

YAS has, as part of its Board-approved Assurance Framework, a Governance structure. It ensures that the strategic objectives and business framework identify the key areas of activity and performance required to meet the Trust’s desired aims.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme’s rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the regulations.

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are met.

5. Review of Effectiveness

As Accountable Offi cer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The head of internal audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.

All risks are reviewed by the appropriate level of management in accordance with the Trust Risk Strategy. The Board, via the Governance Committee, monitors all principal risks to the organisation. The Risk Management team monitors non-clinical and clinical risks via the Health and Safety Committee and Clinical Governance Committee.

The Programme and Project Management team supports all corporate/high cost projects using PRINCE 2 methodology. This ensures that, for the most part, project objectives are delivered to timescales, quality and cost.

The Audit Committee monitors the overall performance of both the Governance structure and Risk Management System with support from Internal Audit.

The Trust has an Assurance Framework in line with Department of Health guidance that has been approved by the Board.

The Assurance Framework identifi ed material gaps in assurance in the following areas:

• Lack of a Board-approved PTS Strategy

• The Trust is not fully compliant with the Core Standards for Better Health.

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• The Trust’s overshoot of its External Financing Limit (EFL) by £612k as reported in the accounts, resulted from the Trust holding a lower cash balance than that required to meet its EFL because of a misunderstanding around the link between the EFL and the Net Borrowing Requirement. It is important to note that the Trust does not have a cash shortfall and this issue is not related to liquidity problems. The EFL overshoot did not result from any underlying liquidity issue or unplanned need for external fi nance. Plans are in place to ensure that this overshoot does not re-occur.

The following signifi cant control issues occurred in the year:

• The Trust achieved 69.4% against the 75% national target for responding to Category A life-threatening emergencies within eight minutes and 90.6% against the 95% national target for responding to Category B emergencies within 19 minutes. This was because of issues in the implementation of the Trust’s plan to deliver the improved performance required to achieve the standards under the ‘Call Connect’ measurement introduced from 1 April 2008. In the case of Category B the Trust was not commissioned to deliver the target by the PCTs in Yorkshire although funding has been made available to ensure delivery in 2009-10. A process has been put in place it to improve the Trust’s operational performance going forward.

• The Trust underachieved against the thrombolysis 60-minute call-to-needle time target. It should be noted that much of Yorkshire is covered by Primary Percutaneous Coronary Intervention (PPCI) which is now accepted as best practice. The Trust is working at the national level to obtain a review of this target to make it more clinically relevant. Also the Trust is working on an action plan for areas not covered by PPCI.

• Although signifi cant progress was made in improving the Trust’s non-emergency PTS in 2008-09 this service incurred a material defi cit against its income. Operational plans are in place to improve this position in 2009-10.

• The Trust made progress in meeting the Healthcare Commission’s Annual Health Check core standards. In 2007-08, 14 standards were not met. In 2008-09, 12 standards were not fully met, although eight of these were met within the year. A clear plan is place to improve compliance against these standards in 2009-10.

Details of the standards not met in 2008-09 are below.

Standard Issue Action

C04d Medicines management

Vehicle-based drugs not implemented across the Trust. Drugs register not fully implemented

Issues expected to be resolved by 31 May 2009

C08b Organisational and personal development

Personal development reviews not up-to-date for the majority of staff

The majority of staff will have had personal development reviews by the end of September 2009

C11b Mandatory training Statutory and mandatory training not progressed suffi ciently across the Trust

Training plan in place to ensure suffi cient progress by the end of March 2010

C24 Emergency preparedness

Testing of non-critical systems yet to take place

Test will be completed by the end of December 2009

Standard End date of non-compliance

Issue originally not met

C04a Healthcare acquired infection/MRSA

31 January 2009 Infection prevention and control audits not in place for the full year. Revised vehicle cleaning procedures not in place for the full year

C04b Management of medical devices

31 March 2009 Policies not in place for the full year

C04c Decontamination of medical devices

31 March 2009 Policies not in place for the full year

C07e Equality and diversity 31 March 2009 Insuffi cient equality impact assessments

C09 Information governance

28 February 2009 No Trust-wide records management policy in place at start of the year. No NHS number strategy in place at the start of the year

C11a Recruitment and training

31 March 2009 Lack of organisation-wide workforce plan at the start of the year

C18 Equality of access and choice

31 March 2009 Lack of approved polices for the full year

C21 Clean and well-designed environment

31 March 2009 Standard cleaning policy not in place across the Trust for the full year

The eight standards which met the required standard during the year are as follows:

Martyn PritchardChief Executive

Date: 9 June 2009

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Salary(bands of £5,000)

£000

Other Remuneration(bands of £5,000)

£000

Benefi ts in Kind(Rounded to the nearest £00)

£00

Salary (bands of £5,000)

£000


£000


£00

Martyn Pritchard - Chief Executive 125-130 0 62 30-35 0 16

Jayne Barnes1 - Chief Executive N/a N/a N/a 90-95 0 40

Ian Walton - Interim Chief Executive N/a N/a N/a 5-10 0 4

Simon Worthington - Director of Finance 100-105 0 57 95-100 0 55

John Darley2 - Director of Operations 60-65 0 20 80-85 0 90

Ian Walton - Director of Operations - A&E 80-85 0 57 70-75 0 50

Rosie Johnson - Director of OD & HR 80-85 6 0 80-85 5-10 0

Alison Walker - Medical Director 100-105 0 0 95-100 0 0

Sue Cooper3 - Business Development Director 5-10 0 3 70-75 0 47

Keeley Townend - Director of ICT 75-80 6 0 70-75 5-10 0

Sarah Fatchett4 - Interim Operations Director - PTS 35-40 0 0 N/a N/a N/a

Sarah Fatchett5 - Director of Operations - PTS 30-35 0 20 N/a N/a N/a



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Salary(bands of £5,000)

£000


£000


£00

Salary (bands of £5,000)

£000


£000


£00

Jo Pollard6 - Director of Urgent Care 45-50 0 0 N/a N/a N/a

Fiona Barr7 - Director of Corporate Affairs 95-100 0 0 N/a N/a N/a

Nick Varey - Chairman 20-25 0 0 15-20 0 0

Stuart Ellis8 - Non-Executive Director 0-5 0 0 5-10 0 0

Roger Holmes - Non-Executive Director 5-10 0 0 5-10 0 0

Nancy Murgatroyd - Non-Executive Director 5-10 0 0 5-10 0 0

Richard Roxburgh - Non-Executive Director 5-10 0 0 5-10 0 0

Nina Wrightson - Non-Executive Director 5-10 0 0 5-10 0 0

Other remuneration and benefi ts in kind relate to car allowances and private use of Trust vehicles respectively.



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1 Left 9 December 20072 Left 30 June 20083 Left 30 April 20084 Appointed 16 June 20085 Appointed 3 November 20086 Appointed 22 September 20087 Appointed 14 April 20088 Resigned 31 December 2008

Salary Entitlements of Senior Managers

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Real increase in pension lump sum at aged 60(bands of £2,500)

£000

Total accrued pension at age 60 at 31 March 2009 (bands of £5,000)

£000

Lump sum at age 60 related to accrued pension at 31 March 2009 (bands of £5,000)

£000

Cash Equivalent Transfer Value at 31 March 2009

£000

Cash Equivalent Transfer Value at 31 March 2008

£000

Real increase in Cash Equivalent Transfer Value

£000

Employer’s contribution to stakeholder pension

£00

Martyn Pritchard Chief Executive

0-2.5 5-7.5 25-30 75-80 374 270 68 0

Simon Worthington Director of Finance

0-(2.5) (2.5)-(5) 25-30 75-80 387 313 46 0

John Darley1 Director of Operations

0-(2.5) 0-(2.5) 15-20 45-50 231 184 7 0

Ian Walton Director of Operations - A&E

0-(2.5) 0-(2.5) 25-30 80-85 533 415 75 0

Rosie Johnson Director of OD & HR

0-2.5 0-2.5 15-20 50-55 256 203 34 0

Sue Cooper2

Business Development Director 0-(2.5) (2.5)-(5) 20-25 65-70 384 321 3 0

Keeley Townend Director of ICT

0-2.5 0-2.5 10-15 30-35 135 100 23 0

Sarah Fatchett3 Director of Operations - PTS

0-2.5 2.5-5 10-15 35-40 153 100 35 0



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1 Left 30 June 2008 2 Left 30 April 2008 3 Appointed 3 November 2008

The Remuneration and Terms of Service Committee

The Remuneration and Terms of Service Committee is a formal sub-committee of the Board.

The Chairman and all the Non-Executive Directors have served as members of the Committee during the year. It meets regularly to review all aspects of pay and terms of service for directors and senior managers. When considering the pay of senior managers the Committee applies the Department of Health annual pay settlement and the guidance on ‘Very Senior Managers’ Pay’.

Pension Entitlements of Senior Managers

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Income and Expenditure Account for the Year Ended 31 March 2009

2008-09£000

2007-08£000

Income from activities 183,081 150,486

Other operating income 3,629 4,524

Operating expenses (184,312) (152,688)

OPERATING SURPLUS/(DEFICIT) 2,398 2,322

Cost of fundamental reorganisation/reconstruction 0 0

Profi t/(loss) on disposal of fi xed assets 3 (212)

SURPLUS/(DEFICIT) BEFORE INTEREST 2,401 2,110

Interest receivable 507 661

Interest payable 0 (116)

Other fi nance costs - unwinding of discount (109) (95)

SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR 2,799 2,560

Public Dividend Capital dividends payable (2,648) (2,309)

RETAINED SURPLUS/(DEFICIT) FOR THE YEAR 151 251

All income and expenditure is derived from continuing operations.

Independent Auditors’ Report to the Board of Yorkshire Ambulance Service NHS Trust

We have examined the summary fi nancial statement of Yorkshire Ambulance Service NHS Trust for the year ended 31 March 2009 which comprises the Income and Expenditure Account, Balance Sheet, Cash Flow Statement, Statement of Total Recognised Gains and Losses and the related notes.

This report is made solely to the Board of Yorkshire Ambulance Service NHS Trust, as a body, in accordance with Part II of the Audit Commission Act 1998. Our audit work has been undertaken so that we might state to the Board those matters we are required to state to them in an auditors’ report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust and the Board as a body, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of Directors and auditors

The directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the summary fi nancial statement within the Annual Report with the statutory fi nancial statements. We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary fi nancial statement.

Basis of opinion

We conducted our work in accordance with Bulletin 1999/6 ‘The auditors’ statement on the summary fi nancial statement’ issued by the Auditing Practices Board. Our report on the statutory fi nancial statements describes the basis of our audit opinion on those fi nancial statements.

Opinion

In our opinion the summary fi nancial statement is consistent with the statutory fi nancial statements of the Trust for the year ended 31 March 2009.

Paul Thomson BA (HONS) ACA

For and on behalf of Deloitte LLPLeeds, United Kingdom

9 June 2009

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Balance Sheet as at 31 March 2009 31 March

2009

£000

31 March

2008

£000

FIXED ASSETS

Intangible assets

Tangible assets

Financial assets

0

74,256

0

65

79,259

0

TOTAL FIXED ASSETS 74,256 79,324

CURRENT ASSETS

Stocks and work in progress

Debtors

Other fi nancial assets

Cash at bank and in hand

1,062

13,435

0

5,002

902

12,353

0

3,650

TOTAL CURRENT ASSETS 19,499 16,905

CREDITORS

Amounts falling due within one year

Financial liabilities

(13,023)

0

(5,180)

0

NET CURRENT ASSETS/(LIABILITIES) 6,476 11,725

TOTAL ASSETS LESS CURRENT LIABILITIES 80,732 91,049

Balance Sheet as at 31 March 2009 31 March

2009

£000

31 March

2008

£000

CREDITORS

Amounts falling due within one year

Financial liabilities

0

0

0

0

PROVISIONS FOR LIABILITIES AND CHARGES (5,887) (7,505)

TOTAL ASSETS EMPLOYED 74,845 83,544

FINANCED BY

TAXPAYERS’ EQUITY

Public dividend capital

Revaluation reserve

Donated asset reserve

Government grant reserve

Other reserves

Income and expenditure reserve

74,001

(3,182)

190

0

0

3,836

73,319

6,596

279

0

0

3,350

TOTAL TAXPAYERS’ EQUITY 74,845 83,544

The fi nancial statements were approved by the Board on 9 June 2009 and signed on its behalf by:

Martyn Pritchard

Chief Executive

Date: 9 June 2009

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Statement of Total Recognised Gains and Losses for the Year Ended 31 March 2009

2008-09

£000

2007-08

£000

Surplus/(defi cit) for the fi nancial year before dividend payments 2,799 2,560

Fixed asset impairment losses 0 0

Unrealised surplus/(defi cit) on fi xed asset revaluations/indexation (9,443) 4,323

Increases in the donated asset and government grant reserve due to receipt of donated and government grant fi nanced assets

29 58

Defi ned benefi t scheme actuarial gains/(losses) 0 0

Additions/(reductions) in “other reserves” 0 0

Total recognised gains and losses for the fi nancial year (6.615) 6,941

Prior period adjustment 0 0

Total gains and losses recognised in the fi nancial year (6.615) 6,941

All income and expenditure is derived from continuing operations.

Management Costs 2008-09£000

2007-08£000

Management costs 12,328 10,725

Income 186,710 155,010

Management costs are defi ned as those on the Department of Health website at: www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_4007923

Better Payment Practice Code Measure of Compliance

2008-09

Number £000

Total Non-NHS trade invoices paid in the year

Total Non-NHS trade invoices paid within target

Percentage of Non-NHS trade invoices paid within target

37,109

24,341

66%

66,149

44,720

68%

Total NHS trade invoices paid in the year

Total NHS trade invoices paid within target

Percentage of NHS trade invoices paid within target

769

433

56%

4,440

3,373

76%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

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Cash Flow Statement for the Year Ended 31 March 2009

2008-09

£000

2007-08

£000

OPERATING ACTIVITIES

Net cash infl ow/(outfl ow) from operating activities 14,648 12,829

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE

Interest received

Interest paid

Interest element of fi nance leases

507

0

0

686

(120)

0

Net cash infl ow/(outfl ow) from returns on investments and servicing of fi nance 507 566

CAPITAL EXPENDITURE

(Payments) to acquire tangible fi xed assets

Receipts from sale of tangible fi xed assets

(Payments) to acquire intangible assets

Receipts from sale of intangible assets

(Payments to acquire)/receipts from sale of fi xed asset investments

(Payments to acquire)/receipts from sale of fi nancial instruments

(14,031)

2,194

0

0

0

0

(8,180)

3,054

0

0

0

0

Net cash infl ow/(outfl ow) from capital expenditure (11,837) (5,126)

DIVIDENDS PAID (2,648) (2,309)

Net cash infl ow/(outfl ow) before management of liquid resources and fi nancing 670 5,960

Cash Flow Statement for the Year Ended 31 March 2009

2008-09

£000

2007-08

£000

MANAGEMENT OF LIQUID RESOURCES

(Purchase) of fi nancial assets with the Department of Health

(Purchase) of other current fi nancial assets

Sale of fi nancial assets with the Department of Health

Sale of other current fi nancial asset

0

0

0

0

0

0

0

0

Net cash infl ow/(outfl ow) from management of liquid resources 0 0

Net cash infl ow/(outfl ow) before fi nancing 670 5,960

FINANCING

Public dividend capital received

Public dividend capital repaid

Loans received from the Department of Health

Other loans received

Loans repaid to the Department of Health

Other loans repaid

Other capital receipts

Capital element of fi nance lease rental payments

Cash transferred (to)/from other NHS bodies

682

0

0

0

0

0

0

0

0

129

0

0

0

(2,908)

0

0

0

0

Net cash infl ow/(outfl ow) from fi nancing 682 (2,779)

Increase/(decrease) in cash 1,352 3,181

Contact us:


Trust Headquarters

Springhill

Brindley Way

Wakefi eld 41 Business Park

Wakefi eld

WF2 0XQ

Tel: 0845 124 1241

Fax: 01924 584095

www.yas.nhs.uk

The full accounts for the year ended 31 March 2009 for the Yorkshire Ambulance Service NHS Trust, together with further copies of this publication, are available on request.

If you would prefer this document in

another format, such as another

language, large print, Braille or audio

tape, please contact our Corporate

Communications department at Trust

Headquarters to discuss your

requirements.

© Yorkshire Ambulance Service NHS Trust

YAS-09-003-03A

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